﻿<?xml version="1.0" encoding="utf-8"?>
<!--176 Court Submission-->
<TransactionSpecification TransactionSetIdentifierCode="176" xmlns="http://tempuri.org/X12ParserSpecification.xsd">
  <Segment SegmentId="BGN" />
  <Segment SegmentId="REF" />
  <Loop LoopId="FGS">
    <Name>Form Group</Name>
    <StartingSegment SegmentId="FGS" />
    <Segment SegmentId="CDS" />
    <Segment SegmentId="DTM" />
    <Segment SegmentId="SPI" />
    <Segment SegmentId="REF" />
    <Segment SegmentId="CRC" />
    <Segment SegmentId="PAM" />
    <Segment SegmentId="BCU" />
    <Segment SegmentId="MSG" />
    <Segment SegmentId="QTY" />
    <Segment SegmentId="CED" />
    <Loop LoopId="LM">
      <Name>Code Source Information</Name>
      <StartingSegment SegmentId="LM" />
      <Segment SegmentId="LQ" />
      <Segment SegmentId="CED" />
      <Segment SegmentId="MSG" />
    </Loop>
    <Loop LoopId="AMT">
      <Name>Monetary Amount</Name>
      <StartingSegment SegmentId="AMT" />
      <Segment SegmentId="DTM" />
      <Segment SegmentId="QTY" />
      <Segment SegmentId="REF" />
      <Segment SegmentId="MSG" />
    </Loop>
    <Loop LoopId="BBC">
      <Name>Legal Claims</Name>
      <StartingSegment SegmentId="BBC" />
      <Segment SegmentId="AMT" />
    </Loop>
    <Loop LoopId="NM1">
      <Name>Individual or Organizational Name</Name>
      <StartingSegment SegmentId="NM1" />
      <Segment SegmentId="N2" />
      <Segment SegmentId="N3" />
      <Segment SegmentId="N4" />
      <Segment SegmentId="REF" />
      <Segment SegmentId="QTY" />
      <Segment SegmentId="PER" />
      <Segment SegmentId="AMT" />
      <Segment SegmentId="PCT" />
      <Segment SegmentId="MSG" />
      <Loop LoopId="BBC">
        <Name>Legal Claims</Name>
        <StartingSegment SegmentId="BBC" />
        <Segment SegmentId="AMT" />
      </Loop>
      <Loop LoopId="DTM">
        <Name>Date/Time Reference</Name>
        <StartingSegment SegmentId="DTM" />
        <Segment SegmentId="CRC" />
      </Loop>
    </Loop>
    <Loop LoopId="EFI">
      <Name>Electronic Format Identification</Name>
      <StartingSegment SegmentId="EFI" />
      <Segment SegmentId="BIN" />
    </Loop>
  </Loop>
</TransactionSpecification>